Houston Foot Specialists

1140 Business Center Drive, Suite 510
Houston, TX 77043

What if it’s NOT Plantar fasciitis?

One of the biggest fears in medicine is NOT getting the right diagnosis. To be honest, Im not sure if your physician is more afraid than you as the patient. In the world of feet, one of the most common complaints that presents in our clinics is heel pain; most commonly diagnosed as plantar fasciitis. Now Im not saying that your local Podiatrist has misdiagnosed you. Please understand that is not the purpose of this blog. Your physician is always running through a list of diagnoses for each complaint they see. This is something we are taught from the very beginning. We refer to it as differential diagnosis. Each diagnosis is ruled in OR out based off of symptoms and tests. Having said all this, what are the differential diagnoses for plantar heel pain?

1. Fracture namely a stress fracture of the calcaneus (heel bone). A true stress fracture is not visible on x-ray and may actually take several x-rays over the course of a week or two before you see the fracture. You can fracture the heel spur that you often hear about.

2. Bone tumor a tumor within the calcaneus can cause heel pain. Often times though you may not know you have a bone tumor and may be an incidental finding.

3. Fat pad atrophy like most things, our fat atrophies and thins as we age. When young, you have a healthy, or should have, layer of fat beneath the calcaneus. This provides some shock absorption as you walk. Thinning of this layer reduces the absorptive capacity and so now more force is placed directly on the calcaneus.

4. Nerve entrapment the most common nerves entrapped causing heel pain are within the tarsal tunnel. We have discussed tarsal tunnel syndrome in a prior blog, so if you have any questions please refer back. Another nerve that may become entrapped within this region is known as Baxters nerve. Believe it or not, an entrapped nerve in the low back can also cause heel pain.

5. Bone bruise yes you can actually bruise bone like your bruise the skin. The one difference is that it takes a little longer for bone to recover.

6. Muscle/Fascial tear its not common, but you can actually tear the muscles OR plantar fascia away from the calcaneus.

So, now you have a small taste of what your physician might be contemplating when your present in the clinic with heel pain. There is a saying in medical school; dont go chasing zebras over horses. What this means is that you need to be looking at more common problems over the rare problem.